Toward specifying the nature of the relationship between expressed emotion and schizophrenic relapse: the utility of curvilinear models

Abstract

Although expressed emotion (EE) has been demonstrated to be associated with the course of schizophrenia, the nature of this relationship is unclear. This study proposes that testing for curvilinear relationships can identify the specific nature of the relationships between EE indices and relapse. The utility of curvilinear models was explored through a reanalysis of data from a prior study of EE among Mexican-Americans (Karno et al., 1987). The results suggest that the relationship between the EE index of emotional overinvolvement (EOI) and relapse is curvilinear and that high levels of EOI may exert a toxic effect on course of illness whereas medium levels of EOI may be protective. The relationship between the EE index of warmth and relapse is also curvilinear and high levels of warmth appear to exert a protective effect on the course of illness. The role of culture is explored in explaining the specific manner in which EE relates to relapse among Mexican-Americans.

Impaired family functioning in psychosis and its relevance to relapse: a two-year follow-up study

“…King & Dixon [19] found that the relapse rate in their sample of young patients with schizophrenia was best predicted by CC from fathers and by EOI in mothers. Even though EOI indicates a different aspect of family function to CC, it has been recently shown that both are associated with negative affect that causes a relapse [49,50]. According to our findings, it may be some aspect of the caregiver's critical attitude towards the patient rather than their self-sacrifice, over-involvement and exaggerated emotional response that accelerates the course of processes leading to a relapse.…”

The impact of caregivers’ expressed emotion and the patients’ perception of expressed emotion on the positive and negative symptoms of patients with schizophrenia in a sample from Turkey

“…Similarly, Bentsen et al (43) could not find a significant relationship between EOI and symptoms assessed by a researcher. On the other side, Breitborde et al (45) indicated that the relationship between the EOI and relapse was curvilinear and that high levels of EOI exerted a toxic effect on the course of illness whereas medium levels of EOI were protective. Similarly, in a recent study with patients in a first episode of psychosis from United Kingdom, Lee et al (46) found the patients were less likely to relapse within 6 and 12-month follow-up periods, when they perceived more positive affect from the family.…”

“…Another limitation of the study is the fact that only one caregiver was interviewed per family and denoted as the main caregiver. There are studies that criticize including only one family member within research (35,45,47). However, in several studies in the literature (13,14) only one family member was assessed as caregiver.…”

How Family Factors Impact Psychosocial Functioning for African American Consumers with Schizophrenia

“…It is hypothesized that the amount of family pressures will have a direct negative effect on amount of family resources based on the burden literature that shows more family burden (a kind of family pressure) is related to fewer family resources (Baronet 1999;Li et al 2007;Magana et al 2007). In addition, the amount of family dysfunction is hypothesized to have a negative relationship with consumer psychosocial functioning based on EE studies (a kind of family dysfunction) (Barrowclough and Hooley 2003;Breitborde et al 2007;McFarlane and Cook 2007). Finally, based on the aforementioned study that showed more family contact had an ameliorating effect on consumer psychosocial functioning, (Guada et al 2009b) the amount of family contact is hypothesized to have a positive direct effect on consumer psychosocial functioning.…”